Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1509 | WI |
NPI | 1003072992 |
---|---|
Provider Name | Martha J Swanson |
First Address | New Richmond, WI 54017-6904 |
Second Address | Hudson, WI 54016-8173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 31/07/2008 |